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Centers for Disease Control and Prevention

Modernizing COVID-19 testing and reporting in non-traditional and under-resourced healthcare settings

Summary

COVID-19 turned places like schools and nursing homes into testing sites. We worked with the Centers for Disease Control and Prevention (CDC) to launch and scale a free, time-saving tool that makes it easy for under-resourced organizations to record results for diagnostic tests and quickly report critical data to public health departments.

A swab test being administered and recorded on a tablet.

The challenge

To respond to disease outbreaks quickly, public health departments need complete, reliable, and actionable disease incidence data. During the COVID-19 pandemic, the test positivity rate has informed policy interventions, such as mask guidance, stay-at-home orders, and limits on indoor activities. Simply put: Better data enables public health departments to make informed decisions quicker, which helps all of us.

The scale of the COVID-19 pandemic has required testing to expand outside of traditional health settings to facilities such as K-12 schools and retirement communities. However, collecting and sending accurate testing data in these settings is difficult — if it happens at all. Non-traditional point-of-care (POC) testing facilities typically lack IT infrastructure to send data to public health departments. Many record results on paper then fax them to the appropriate department, a time-consuming process that’s usually outside a test administrator’s primary job. Patients are also less likely to provide demographic information in these unconventional settings, leading to incomplete and lower-quality data for health departments.

Adding to the complexity are health departments’ differing requirements. As one interviewee who reports to multiple jurisdictions noted:

It’s a challenge to do the test, put it on paper, then go back and enter it in both formats — for the county and state.

Even when facilities do have tools to track patients and results, many lack the ability to automatically report to their jurisdictions, in the different formats that they require.

On the receiving end, public health departments have to process manual reports sent from a variety of locations, which takes time and can result in errors. This can make it difficult to act fast and stay informed.

The solution

To strengthen COVID-19 testing data, the Centers for Disease Control and Prevention (CDC) and the U.S. Digital Service (USDS) launched a multi-year collaboration called the Pandemic-Ready Interoperability Modernization Effort (PRIME). Skylight has supported this work by helping to launch and grow SimpleReport, a free tool that makes it easy to record results for rapid POC tests and quickly report data to public health departments.

SimpleReport is designed to be used as both a workflow and reporting tool for any POC test, regardless of whether or not it has a digital connection. SimpleReport results are automatically sent to public health departments via a single point of connection called ReportStream, which is also part of PRIME. As one interviewee described the reporting process:

Going from what we were doing to this is awesome. It’s very easy to use.

SimpleReport results get to public health in the format and at the cadence that departments request. SimpleReport also provides structured data to health departments, so they don’t have to spend time on additional clean-up.

After the Skylight team fully assumed SimpleReport management from our USDS partners, we’ve continued making the tool as easy to use as possible while expanding its functionality. Our team focused on continually improving and growing SimpleReport through:

  • Enabling scaling by redesigning the account creation, login, and password reset experiences, which sped up onboarding while maintaining security
  • Focusing on health equity by providing patient-facing Spanish content and collecting better demographic data with tools for patients to self-register
  • Proving the ability to support other diseases by adding test result recording for multiplex devices, which test for both COVID-19 and flu
  • Growing SimpleReport’s reporting capabilities by adding and iterating on a feature that allows users to upload test results in bulk using a CSV file
  • Easing reporting that facilities need to do beyond public health, including adding one-click results download and an analytics dashboard
  • Maintaining high performance by implementing automated service monitoring; working closely with the CDC support team to resolve end-user issues; and providing 24/7 on-call engineering support
  • Using continuous integration and continuous deployment (CI/CD) practices for secure and fast development — for example, when code is pushed to production, it’s merged in 20 minutes
  • Ensuring SimpleReport meets high accessibility standards by integrating reviews in design and engineering workflow

As we continue to support ongoing COVID-19 reporting, we’re also focusing on pandemic readiness and filling in gaps in other public health reporting. To further this goal, the team is conducting a pilot to explore using SimpleReport to report additional diseases beyond COVID-19 and flu.

By building out and linking public health infrastructure where these connections didn’t exist before, SimpleReport, along with the other PRIME projects, is fundamentally changing how disease incidence reporting is happening in the U.S. These tools are laying the structural groundwork for efficient and effective responses to future health crises.

The results

  • Over 6.8M tests have been performed since launch (from Jan 2021 to Nov 2022)
  • Over 11,500 facilities are reporting tests through SimpleReport
  • The tool has been used to test patients from all 50 states, as well as other U.S. territories and Canadian provinces
  • More than 2.4M total text messages sent notifying patients of their test result
  • SimpleReport was used as an example of a Data Modernization Initiative (DMI) success story in a presentation to CDC Director Dr. Walensky for its “game-changing” work in Alaska
  • Given the success of the tool, the CDC is exploring other use cases where SimpleReport can be used to increase reporting from the field

Let’s deliver together.

However bold the idea or complex the problem, we work with you
to deliver results in weeks, not years.